We are spotting an alarming trend of eating disorders amongst our younger patients. It reminds us of comparable features in other disorders of eating. This week’s highlight is orthorexia nervosa.
Orthorexia nervosa is a pathological compulsion or obsession with healthy eating and nutritional quality of meals. While being mindful and cautious of the food you eat is not an issue in itself, people with orthorexia nervosa are so focused on healthy eating that they present with restrictive dietary practices. These dietary restrictions can worsen over time. Entire food groups may be eliminated (sugar, carbohydrates, meat, dairy, etc.) and the compulsive behavior can end up impairing the individual’s physical health. In addition, mental health can also be affected when the individual undergoes distress due to compulsive eating behaviors. Especially when heavy emphasis is placed on complying with self-defined healthy eating behaviors in order to maintain a positive body image or self-worth. When orthorexic individuals “break” their eating habits, they may experience feelings of shame and guilt, and may feel like they must undergo self-punishment.
This extreme method of eating habits can lead to the same outcomes seen in people with severe anorexia. This can include nutritional deficiencies and weight loss. Similar to anorexia, orthorexia nervosa is characterized by restricting the amount and types of foods eaten. However, patients with orthorexia do not typically have a fear of gaining weight and being perceived as overweight as seen in anorexic patients; rather, orthorexic individuals focus on avoiding foods they think are bad and heavily embracing foods they deem as healthy. They could spend long periods of time researching foods, measuring food amounts, planning meals, and talking about “healthy eating” to their colleagues, friends, and family.
Orthorexia nervosa also heavily overlaps with obsessive compulsive disorder (OCD), in which orthorexic individuals tend to have recurrent, intrusive thoughts about health and food at inappropriate times. They can develop an almost ritualistic approach to eating. Feelings of anxiety may be induced if the restrictive diet cannot be followed. Many orthorexic individuals are also at risk for social isolation over time because they do not believe they can maintain their “healthy eating” around others, and can only maintain it while eating alone. This way, they can have complete control over their surroundings.
While interventions for orthorexia nervosa are currently lacking and still being researched, the ideal treatment plan involves a multidisciplinary team of physicians, dieticians, psychotherapists, and other healthcare providers working together and treating the different characteristics that make up the disorder. This is the playbook that we use for anorexia nervosa. Current practices suggest that this disorder is best treated using a combination of cognitive behavioral therapy, medications, and psychoeducation.
Where this becomes important for our clinic is in the treatment of bacterial overgrowth, irritable bowel syndrome, and inflammatory bowel disease. We must walk a tightrope between giving nutritional information that is helpful to curing the condition, but not triggering their emotional disorder of eating. In the future, we will highlight how we navigate this challenge.